Provider Demographics
NPI:1932179744
Name:SPACCAVENTO, COLETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:COLETTE
Middle Name:
Last Name:SPACCAVENTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E 59TH ST
Mailing Address - Street 2:SUITE 9C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1304
Mailing Address - Country:US
Mailing Address - Phone:212-583-2850
Mailing Address - Fax:212-644-8666
Practice Address - Street 1:110 E 59TH ST
Practice Address - Street 2:SUITE 9C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1304
Practice Address - Country:US
Practice Address - Phone:212-583-2850
Practice Address - Fax:212-644-8666
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY145008207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY145008OtherLICENSE
NY145008OtherLICENSE
NYB19108Medicare UPIN
NYAS2871843OtherDEA#